Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2005
Comparative StudyThe ProSeal has a shorter life-span than the Classic laryngeal mask airway.
We tested the hypothesis that the life-span of the ProSeal laryngeal mask airway (LMA) is shorter than the Classic LMA. We also compared residual cuff volumes and changes in elastance and permeability with use. Six new size 4 ProSeal LMAs and 6 new size 4 Classic LMAs were tested. ⋯ The residual cuff volume was higher for the ProSeal LMA (2.6 +/- 1.3 mL versus 1.5 +/- 0.9, P = 0.04). We conclude that the life-span of the ProSeal LMA is shorter than the Classic LMA, but both exceed the manufacturer's recommendations of 40 uses. We recommend that reusable LMA devices be discarded when they fail the pre-use check tests, rather than after a specific number of uses.
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Anesthesia and analgesia · Feb 2005
Clinical TrialThe timing of acupuncture stimulation does not influence anesthetic requirement.
Studies suggest that acupuncture is more effective when induced before the induction of general anesthesia than afterwards. We tested the hypothesis that electro-acupuncture initiated 30 min before the induction reduces anesthetic requirement more than acupuncture initiated after the induction. Seven volunteers were each anesthetized with desflurane on 3 study days. ⋯ The P(50) of logistic regression identified desflurane requirement. Desflurane requirement was similar on the Control (mean +/- sd; 5.2% +/- 0.6%), Preinduction (5.0% +/- 0.8%), and At-induction (4.7% +/- 0.3%; P = 0.125) days. This type of acupuncture is thus unlikely to facilitate general anesthesia or decrease the requirement for anesthetic drugs.
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Anesthesia and analgesia · Feb 2005
Randomized Controlled Trial Clinical TrialContinuous gastric decompression for postoperative nausea and vomiting after coronary revascularization surgery.
Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. ⋯ The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.
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Anesthesia and analgesia · Feb 2005
Airway management in adult patients with deep neck infections: a case series and review of the literature.
Patients with deep neck infections, especially those with Ludwig's angina, may die as a result of airway management mishaps. Skillful airway management is critical, but a safe method of airway control in these patients is yet to be established. We subjected patients with deep neck infections to fiberoptic tracheal intubation by using topical anesthesia to provide general anesthesia for surgical interventions. ⋯ Twelve patients remembered part of the procedure, and two considered it unpleasant. Tracheal intubation with a flexible bronchoscope by using topical anesthesia is highly successful in adult patients with deep neck infections. Tracheostomy using local anesthesia is recommended if fiberoptic intubation is not feasible, if the clinician is not skillful in the use of awake fiberoptic intubation, or if intubation attempts have failed.
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Anesthesia and analgesia · Feb 2005
Case ReportsBispectral index as an indicator of cerebral hypoperfusion during off-pump coronary artery bypass grafting.
Bradycardia and hypotension are common during off-pump coronary artery bypass grafting (OPCAB). We present a case of possible reversible global cerebral hypoperfusion during distal grafting of the left circumflex coronary artery. The bispectral index (BIS) suddenly decreased from values of 45-50 to 0 during distal grafting. ⋯ Postoperative recovery was uneventful and the patient was discharged 5 days after surgery. Cerebral hypoperfusion is a possible complication during OPCAB. BIS monitoring in OPCAB could be an indicator of cerebral hypoperfusion.